Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 5101013693 | MI |
NPI | 1427003334 |
---|---|
Provider Name | Douglas Eugene Pugmire |
First Address | Rochester Hills, MI 48309 |
Second Address | Rochester Hills, MI 48309-3712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 01/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114258903 | (05) | MI |
1653301685 | BLUE CROSS BLUE SHIELD (01) | MI |
200000015991 | PHPMM (01) | MI |
G56659 | (02) | MI |